纳布啡复合异丙酚对腹腔镜疝气手术患儿血流动力学、疼痛介质的影响

Effects of nalbuphine combined with propofol on hemodynamics and pain mediators in children with laparoscopic hernia surgery

目的探讨纳布啡复合异丙酚对腹腔镜疝气手术患儿血流动力学、疼痛介质的影响。方法选取该院2020年1月至2021年12月收治的腹腔镜疝气手术患儿70例,使用随机数字表法将所有患儿分为对照组及研究组,每组35例,对照组患儿使用芬太尼+丙泊酚进行麻醉,研究组采用纳布啡+丙泊酚。观察比较两组患儿术中情况、血流动力学、术后疼痛情况及术后疼痛介质表达、不良反应发生率。结果研究组丙泊酚用量、Ambesh评分显著低于对照组,差异有统计学意义(P<0.05);研究组体动分级Ⅰ/Ⅱ级患儿例数显著高于对照组,Ⅲ级患儿例数显著低于对照组,差异有统计学意义(P<0.05);两组患儿入室时血流动力学指标比较差异无统计学意义(P>0.05);研究组术后血清前列腺素E2、P物质、降钙素基因相关肽、神经肽Y水平低于对照组,差异有统计学意义(P<0.05)。研究组不良反应发生率显著低于对照组,差异有统计学意义(P<0.05)。结论纳布啡复合异丙酚能有效降低腹腔镜疝气手术患儿血流动力学变化,减轻术后疼痛、术中躁动症状,具有较好镇静作用且不增加不良反应,具有临床推广价值。

Objective To explore the effect of nalbuphine combined with propofol on hemodynamics and pain mediators in children with laparoscopic hernia surgery.Methods A total of 70 children with laparoscopic hernia surgery who were admitted to the hospital from January 2020 to December 2021 were selected,and all children were divided into the control group and the study group by random number table method,with 35 cases in each group.The children in the control group were anesthetized with fentanyl and propofol,and the study group used nalbuphine and propofol.The intraoperative conditions,hemodynamics,postoperative pain,postoperative pain mediator expression,and incidence of adverse reactions were observed and compared between the two groups.Results The dosage of propofol and Ambesh score in the study group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The number of chidren in body movement gradeⅠ/Ⅱof the study group was significantly higher than that in the control group,and the number of chidren in body movement gradeⅢof the study group was significantly lower than that in the control group,the differences were statistically significant(P<0.05).There was no significant difference in hemodynamic parameters between the two groups(P>0.05).The postoperative serum levels of prostaglandin E2,substance P,calcitonin gene-related peptide and neuropeptide Y in the study group were lower than those in the control group,the differences were statistically significant(P<0.05).The incidence of adverse reactions in the study group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Nalbuphine combined with propofol can effectively reduce intraoperative agitation and hemodynamic changes in children with laparoscopic hernia surgery,relieve postoperative pain,and has a good sedative effect without increasing adverse reactions,which has clinical promotion value.